ssris and suicide in adults

ssris and suicide in adults Th ere is strong evidence that suicide rates have dropped in the United States
since 1986, which many researchers claim is a direct result of increasing prescriptions
of antidepressants, especially the SSRIs (Grunebaum, Ellis, Li,
Oquendo, & Mann, 2004). Recently, however, the FDA added a “black box”
danger warning to all antidepressants in order to warn doctors and patients
about the increased risk of suicidal thoughts and behavior in children and
adolescents being treated with antidepressants (FDA News, 2004). How are
patients and doctors to make sense of this confusing information? In many
ways, neither of these fi ndings is very surprising. Th ere is no doubt that the
antidepressants have helped many people, both young and old, overcome problems or side eff ects.
When the tricyclic antidepressants were the mainstay of antidepressant
treatment, it was recognized that the early weeks of treatment were especially
risky, since patients sometimes began to have more energy before their mood
started to lift . As a result, energized but still miserable patients ran a higher
risk for self-harm. It seems reasonable to assume that the same thing may happen
with SSRIs as well. In addition, some patients experience akathisia when
they begin SSRI treatment, especially when they receive higher doses than
are tolerable. To compound matters, many clinicians have prescribed SSRIs to
children and adolescents at full adult doses, which increases the likelihood of
akathisia. Th is phenomenon may be the central cause of increased irritability,
impulsivity, and suicidal thoughts and feelings at the start of treatment.
Additionally, any antidepressant can evoke mania in vulnerable individuals.
Th ere is controversy as to whether someone who develops mania while
taking an antidepressant is truly bipolar. In any event, this response may also
be dose dependent, and since children frequently receive doses that are too
high, there are probably more cases of mania in children than in adults. Manic
reactions following SSRI treatment also may lead to increases in dangerous
and impulsive behavior, especially among children.
Finally, it may be that the apparent increase in danger in children and adolescents
sometimes refl ects the synergistic combination of SSRIs and unreported
illicit substances. As noted above, some patients have brief, intense
responses to marijuana and serotonergic hallucinogens (e.g., LSD) while
taking an SSRI. Th ese reactions may present as brief mania, psychosis, or an intensifi ed response to the drug; some people respond to marijuana as if they had ingested LSD. For a thorough and accessible discussion of this topic, see Mahler